Systems for soft tissue repair

ABSTRACT

A tissue repair apparatus includes a housing, a rotatable shaft at least partially disposed within the housing, and first and second curved needles coupled to the shaft. The housing defines a gap between a first edge of the housing and a second edge of the housing, the gap adapted to receive tissue. The first and second needles curved needles being articulable within the housing from a delivery position, at which the first and second needles are spaced from the gap, to a deployed position, at which the first and second needles extend through the gap. Actuation of the shaft simultaneously articulates the first and second needles and the first needle enters the gap before the second needle enters the gap.

BACKGROUND OF THE INVENTION

The present invention relates generally to medical devices and methodsfor repairing soft tissue. More particularly, the present inventionrelates to devices and methods for reattaching torn soft tissue endssuch as a ruptured Achilles tendon in a minimally invasive manner.

Soft tissue damage, particularly a ruptured Achilles tendon, is often adebilitating event that necessitates surgery. Reattaching a rupturedAchilles tendon generally requires that the torn or ripped ends of thetendon be coapted by passing one or more sutures through each damagedend. Each of the torn ends may then be drawn towards one another bytightening the sutures to restore the connecting muscles and tendon totheir original lengths.

Accessing the damaged tissue, however, generally requires relativelylarge incisions, or multiple smaller incisions, for effecting adequatepurchase and sufficient suturing of the damaged tendon to ensure properhealing of the tendon. Nonetheless, relatively large incisions, ormultiple incisions, increase the likelihood of infections and result inprolonged recovery periods.

Minimally invasive devices, which may be inserted through relativelysmaller incisions, are generally limited in their application forrepairing particular tissue regions. For instance, while minimallyinvasive devices may enable a surgeon to pass sutures through tissue,these instruments are often limited in their ability to pass multiplesutures through non-supported tissue structures in an efficaciousmanner. Moreover, many such devices are insufficient in supportingunsupported tissue structures such as a ruptured Achilles tendon duringsuturing.

Nevertheless, due to the complications of open surgical operations,minimally invasive tissue repair systems are of continued interest. Twosuch tissue repair systems, are disclosed in U.S. Pat. Nos. 8,936,611and 9,289,205, each of which is assigned to Applicant and incorporatedherein by reference in its entirety.

BRIEF SUMMARY OF THE INVENTION

In repairing damaged regions of tissue, the elongated housing disclosedherein may be introduced through a single incision to access damagedtissue such as a ruptured or torn Achilles tendon and to pass multiplesutures through the tendon. Thus, the tendon repair assembly maygenerally include a housing, a rotatable shaft at least partiallydisposed within the housing, and first and second curved needles. Thehousing defines a gap between a first edge of the housing and a secondedge of the housing, the gap being adapted to receive tissue. The firstand second curved needles are articulable within the housing from adelivery position, at which the first and second needles are spaced fromthe gap, to a deployed position, at which the first and second needlesextend through the gap. Rotation of the shaft simultaneously articulatesthe first and second needles such that the first needle enters the gapbefore the second needle enters the gap.

A base end of the first needle and a base end of the second needle aremounted on an outer surface of the rotatable shaft along an axis thatextends parallel to a longitudinal axis of the rotatable shaft. Thefirst and second needles and the rotatable shaft may be a singlemonolithic structure and the first needle may have a greater length thanthe second needle.

The first needle may include a first notch spaced a first distance froma piercing tip of the first needle and the second needle may include asecond notch spaced a second distance from a piercing tip of the secondneedle such that the first distance is greater than the second distance.The first needle may define a suture channel along an outer portion ofthe first needle and the second needle may define a suture channel alongan outer portion of the second needle.

The tissue repair apparatus may further include a suture having a firstportion disposed in the suture channel of the first needle forming afirst loop, and a second portion disposed in the suture channel of thesecond needle forming a second loop. The first needle may include afirst notch spaced a first distance from a piercing tip of the firstneedle and the second needle may include a second notch spaced a seconddistance from a piercing tip of the second needle such that the firstdistance is greater than the second distance and the first portion ofthe suture spans the first notch and the second portion of the suturespans the second notch.

The system may further include a stylet adapted to carry a cinchingsuture. The stylet may be slidably disposed within a locking channeldefined within a wall of the housing. The first needle may include afirst notch spaced a first distance from a piercing tip of the firstneedle and the second needle may include a second notch spaced a seconddistance from a piercing tip of the second needle, the first distancebeing greater than the second distance, such that when the first needleand the second needle are in the deployed position, the first notch andthe second notch are longitudinally aligned with one another along thelocking channel.

In another embodiment, a tissue repair apparatus includes a housingdefining a gap between a first edge of the housing and a second edge ofthe housing, a rotatable shaft at least partially disposed within thehousing, and a plurality of curved needles connected to the rotatableshaft. The gap is adapted to receive tissue. The plurality of curvedneedles is articulable from a delivery position in which the pluralityof curved needles is spaced from the gap to a deployed position in whichthe plurality of curved needles extends through the gap. Rotation of theshaft simultaneously articulates the plurality of curved needles andeach one of the plurality of curved needles enters the gap in asequential order.

When the plurality of needles are in the delivery position, each one ofthe plurality of needles is at least partially positioned within a wallof the housing and on a single side of the gap. A base end of each ofthe plurality of needles may by be mounted on an outer surface of therotatable shaft along an axis that extends parallel to a longitudinalaxis of the rotatable shaft. The plurality of curved needles may includea first curved needle having a first arc length, a second curved needlehaving a second arc length, and a third curved needle having a third arclength such that the first arc length is longer than the second arclength and the second length is longer than the third arc length. Eachone of the first curved needle, the second curved needle, and the thirdcurved needle may define a suture channel along an outer radial edge ofthe needle.

The first curved needle may include a first notch spaced a firstdistance from a piercing tip of the first needle, the second curvedneedle may include a second notch spaced a second distance from apiercing tip of the second needle, and the third needle may include athird notch spaced a third distance from a piercing tip of the thirdneedle such that the first distance is greater than the second distanceand the second distance is greater than the third distance.

When the plurality of needles are in the deployed position, the firstnotch, the second notch, and the third notch are longitudinally alignedwith one another along a locking channel provided within the housing.

The tissue repair apparatus may further include a stylet adapted tocarry a cinching suture, the stylet being slidably disposed within thelocking channel. In some instances, the locking channel may be at leastpartially disposed within a wall of the housing. The tissue repairapparatus may also include a contiguous suture having a first portiondisposed in the suture channel of the first needle forming a first loop,a second portion disposed in the suture channel of the second needleforming a second loop, and a third portion disposed in the suturechannel of the third needle forming a third loop.

A piercing end of at least one of the plurality of needles may includedual prongs and at least a portion of the suture channel may be providedbetween the prongs. Additionally, or alternatively, a piercing end of atleast one of the plurality of needles may include a single prong. Thesingle prong may be substantially triangular in shape and tapered from afirst lateral side of the single prong to a second lateral side of thesingle prong.

In yet another embodiment, a method for repairing a tissue regionincludes positioning a portion of a ruptured or torn tendon tissuewithin a tissue receiving gap defined in a housing of a suture deliveryassembly and simultaneously actuating first and second needles at leastpartially through the tissue receiving gap such that the first andsecond needles respectively pierce the ruptured or torn tendon tissue atfirst and second locations with the first needle entering the tissuereceiving gap before the second needle enters the tissue receiving gap.

The first needle may define a first stylet clearance slot spaced a firstdistance from a piercing tip of the first needle and the second needlemay define a second stylet clearance slot spaced a second distance froma piercing tip of the second needle, the first distance being greaterthan the second distance. When the first needle and the second needleare in a deployed position, the first stylet clearance slot and thesecond stylet clearance slot are longitudinally aligned with one anotheralong a locking channel of the housing.

The method may further include the step of passing a suture through theruptured or torn tendon tissue at the first location and the secondlocation and advancing a stylet carrying a cinching suture in alongitudinal direction through the suture delivery assembly and throughthe first stylet clearance slot and the second stylet clearance slot.

Introduction of the suture delivery assembly may include introducing thesuture delivery assembly through a single incision along a posteriorregion of a leg. After the tissue region has been repaired, the firstneedle and the second needle may be retracted and the suture deliveryassembly may be withdrawn from the incision. In some instances, theruptured or torn tendon tissue may be the Achilles tendon.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a schematic representation of a human ankle and footincluding the Achilles tendon.

FIG. 1B is a schematic representation of the human ankle and foot andillustrating a ruptured Achilles tendon.

FIG. 2A is a front facing perspective view of a suture delivery deviceaccording to an embodiment of the present disclosure.

FIG. 2B is a rear facing perspective view of the suture delivery deviceof FIG. 2A.

FIG. 2C is an exploded view of the suture delivery device of FIG. 2B.

FIG. 3A is a bottom facing perspective view of a housing of the suturedelivery device of FIG. 2B.

FIG. 3B is a bottom facing perspective view of the housing and needleassembly of FIG. 2B illustrating the needle assembly in a deliveryposition.

FIG. 3C is a bottom facing perspective view of the housing and needleassembly of FIG. 2B illustrating the needle assembly shortly after ithas been actuated.

FIG. 3D a bottom facing perspective view of the housing and needleassembly of FIG. 2B illustrating the needle assembly in a deployedposition.

FIG. 4A is a perspective view of an exemplary needle assembly in whicheach needle has a single prong.

FIG. 4B is a front plan view of one of the needles shown in FIG. 4A.

FIG. 4C is a perspective view of the needle shown in FIG. 4B.

FIG. 4D is a top view of the needle shown in FIG. 4B.

FIG. 5A is a bottom plan view of another exemplary needle assembly inwhich each needle has a double pronged tip.

FIG. 5B is a bottom plan view of another exemplary needle assembly inwhich each needle has a double pronged tip.

FIGS. 6A and 6B is a schematic illustration depicting the manner inwhich a suture is weaved through an Achilles tendon using the needleassembly of FIG. 2B.

FIGS. 7A-7E are schematic views showing the use of the suture deliverydevice of FIG. 2B for attaching one or more sutures to first and secondAchilles tendon portions and securement of the first and second portionsto one another.

DETAILED DESCRIPTION

FIG. 1A is a schematic representation of an Achilles tendon AT, theropelike band of fibrous tissue located in the posterior region of theankle that couples the plantaris (not shown), gastrocnemius G and soleusmuscles S to the calcaneus bone C. These muscles, acting via theAchilles tendon, cause plantar flexion and dorsiflexion of the foot atthe ankle and flexion at the knee.

As a result of direct trauma to the tendon or injury to the lower leg,foot, or ankle, the Achilles tendon may rupture, as shown in FIG. 1B,when a sudden force is placed on the tendon that is greater than thetendon can endure. Once the Achilles tendon has ruptured or been severedinto a first Achilles tendon portion AT1 and a second Achilles tendonportion AT2, flexion at the foot and knee is no longer possible,rendering basic functions of the foot, such as walking, incrediblydifficult. As a result, a ruptured Achilles tendon often requiressurgery to coaptate the severed ends of the tissue and restore properfunction to the foot and ankle.

The devices and methods described herein are configured to suture thesevered ends of the first and second Achilles tendon portions AT1, AT2to one another in a minimally invasive manner. Although the devices andmethods are described herein in connection with the repair of theAchilles tendon, it will be appreciated that these concepts may beequally applicable to the repair of other tendons or tissue regions.

A tissue repair device 10, as shown in FIGS. 2A-2C, includes a housing12, a stylet 13, and an elongated shaft 14 having a plurality of needles16, 18, 20 (collectively “needle assembly”) disposed within andarticulable through the housing.

Housing 12 includes a handle 22 having an ergonomically shaped grip 24for manipulating tissue repair device 10. As shown, housing 12 andhandle 22 are a monolithic component, however, it will be appreciatedthat the handle may also be connected to or otherwise coupled to thehousing. Handle 22 is preferably angled about a longitudinal axis L ofhousing 12, for example, from about 30 degrees to about 90 degrees. Thisangled orientation allows the user to insert housing 12 through anincision in a posterior region of a patient's leg to access the Achillestendon without interference from the patient's lower leg.

Handle 22 further includes actuator 26 for actuating rotation of shaft14 and, in turn, articulating the needle assembly. Although actuator 26is shown in FIGS. 2A-2C as a rotatable member extending generallyperpendicular to handle 22, it will be appreciated that the actuator mayalternatively be formed as a pressable button, a trigger, or any othermechanism known in the art configured to cause rotation of shaft 14.

Referring to FIG. 3A-3D, housing 12 is generally elongated in shape witha hollow interior for receiving a ruptured Achilles tendon. Housing 12extends along longitudinal axis L from a proximal end 28 nearest handle22 to an opposing distal end 30 and may be a thin metal tube that actsas a cover or stiffening component for the features described below.

The distal end 30 of housing 12 may be rounded or otherwise atraumaticin shape to prevent damage of surrounding tissues when the housing isintroduced into the leg of a patient. Housing 12 may have a length ofabout 5.6 cm, although the housing may be lengthened or shortened asdesired. Moreover, housing 12 may have a semi-circular cross-sectionalshape ranging, for example, from between 1 to 2.5 cm in diameter. Inother variations, the cross-sectional shape may be elliptical or anothershape conducive for atraumatic insertion into the patient's body.

Housing 12 has an opening 32 extending along a bottom side 34 of thehousing that allows a ruptured Achilles tendon to be inserted into thehollow interior. The bottom side 34 of housing 12 may be inwardlytapered to assist a user in sliding Achilles tendon portions AT1, AT2into the hollow interior. Housing 12 further defines a shaft cavity 36in which shaft 14 is rotatably secured.

Shaft cavity 36 divides the interior of housing 12 into a first sidehaving a pre-deployment wall 38 and a second side having deployment wall40 such that a gap 42 is formed therebetween. Gap 42 is defined by theinner most edges of the pre-deployment and deployment walls 38, 40. Bothpre-deployment and deployment walls 38, 40 may be generally convex inshape relative to longitudinal axis L.

Pre-deployment wall 38 defines a plurality of needle recesses 44, 46, 48in which needles 16, 18, 20 are respectively housed in a deliveryposition (e.g., before actuation). As shown in FIG. 3B, needle recesses44, 46, 48 have a depth sufficient to completely conceal needles 16, 18,20 behind an interior face of pre-deployment wall 38 such that theneedles do not extend into gap 42 when the needle assembly is in thedelivery position. Although illustrated with needle recesses 44, 46, 48,it will be appreciated that housing 12 may include any number of needlesrecesses including fewer than three recesses or more than three recessessuch that the number of needle recesses correspond to the number ofneedles provided in the needle assembly.

Deployment wall 40 defines a plurality of needle receiving slots 50, 52,54 that respectively oppose needle recesses 44, 46, 48 and receiveneedles 16, 18, 20 when the needle assembly is in a deployed position(e.g., after actuation) as shown in FIG. 3D.

Housing 12 also defines a stylet channel 56 that wraps around aperimeter of the housing. Stylet channel 56 is preferably concealedbehind an interior face of pre-deployment wall 38 and an interior faceof deployment wall 40 such that the stylet channel extends throughneedle receiving slots 50, 52, 54.

Referring to FIG. 3C, the portion of stylet channel 56 that extends fromthe proximal end 28 of housing 12 toward the distal end 30 of thehousing and is located behind pre-deployment wall 38 is referred toherein as the loading portion 57. The portion of stylet channel 56 thatextends from the distal end 30 of housing 12 toward the proximal end 28of the housing and is located behind deployment wall 40 is referred toherein as the locking channel 59. The arcuate portion of stylet channel56 that extends along the distal end 30 of housing 12 from loadingportion 57 to locking channel 59 is referred to herein as the transitionsection 60.

As is shown in FIGS. 2C, 3C and 3D, stylet 13 may be an elongated, thin,flexible ribbon having a bullet-shaped tip 61, or guide runner, and anaperture 63 that acts as an eyelet for carrying a cinching suture 60.Stylet 13 may be pre-loaded (or loaded by a user before operation) intostylet channel 56 via loading portion 57 and positioned as shown in FIG.3C, such that the tip is located at the distal end of locking channel59. Thus, as will be explained hereinafter, as stylet 13 slides throughlocking channel 59, cinching suture 60 is passed through the lockingchannel and each one of needle receiving slots 50, 52, 54.

With specific reference to FIG. 3B, shaft cavity 36 may define a groove64 that is adapted to receive a correspondingly shaped protrusion 66provided on a proximal end of shaft 14, and a pocket 68 at the distalend 30 of housing 12 for rotatably securing the shaft within the shaftcavity.

As shown in FIGS. 4, 5A, and 5B, needles 16, 18, 20 may be integral withshaft 14 such that the needle assembly and the shaft are formed as asingle monolithic piece. Alternatively, the needle assembly may beconnected to or otherwise coupled to shaft 14 after formation of eachcomponent. Each one of needles 16, 18, 20 are curved or arcuate in shapeand include base ends 70, 72, 74 extending from an outer surface ofshaft 14 towards free ends or needle tips 76, 78, 80. The base ends 70,72, 74 of needles 16, 18, 20 may be mounted on an outer surface ofrotatable shaft 14 along an axis that extends parallel to a longitudinalaxis of the rotatable shaft.

Needle 16 has a first arc length L1, needle 18 has a second arc lengthL2 that is greater than the first arc length of needle 16, and needle 20has a third arc length L3 that is greater than the second arc length ofneedle 18. For example, L1 may be about 0.38 cm to about 0.43 cm, L2 maybe about 0.43 cm to about 0.46 cm, and L3 may be about 0.47 cm to about0.53 cm although other dimension are contemplated. In one embodiment, L1is 0.41 cm, L2 is 0.45 cm, and L3 is 0.49 cm. In another embodiment,based on the arc length of the shortest needle, each successively largerneedle can be about 10% longer. Moreover, needle 16 is spaced a firstdistance L4 from needle 18 and needle 18 is spaced a second distance L5from needle 20. As is shown in FIG. 5A, the first distance L4 may beequal to the second distance L5, for example, L4 and L5 may be about0.75 cm. However, in alternative embodiments, L4 may be less than, orgreater than L5. In further embodiments, more than three needles can beprovided, and the distance between adjacent needles at one end can beshorter than the distance between adjacent needles at the opposite endof the needle array. This can be useful where a more secure grip in thetissue is desired at an area closer to the tear, for example.

Each one of needles 16, 18, 20 may have an equal curvature, i.e. anequal radius of curvature about which they extend. Thus, when shaft 14is rotated, each one of needles 16, 18, 20 simultaneously begins toarticulate through housing 12 and needle tips 76, 78, 80 enter gap 42 ina sequential order (e.g., needle tip 80 enters the gap first, followedby needle tip 78, followed by the needle tip 76) as shown in FIG. 3C. Asa result, the needle assembly provided herein is configured tosequentially pierce a tendon (as opposed to concurrently). As usedherein, sequential order or sequentially means at least one of theneedles enters the gap at a different time than at least one of theother needles. By spacing out the times at which needles 16, 18, 20pierce the tendon, the impact forces that are exerted on the tendon arereduced and the risk of trauma is minimized.

As shown in FIGS. 3C, 4, and 5B a notch 82 is provided in each one ofneedles 16, 18, 20. Notches 82 may be provided in an innercircumferential edge 84 (FIG. 4) or an outer circumferential edge 90(FIG. 5B) of needles 16, 18, 20 and may be provided an equal distancefrom base members 70, 72, 74. In other words, the notch of needle 16 isspaced a first distance D1 from needle tip 76, the notch of needle 18 isspaced a second distance D2 from needle tip 78, the second distancebeing greater than the first distance, and the notch of needle 20 isspaced a third distance D3 from needle tip 80, the third distance beinggreater than the second distance. This spacing ensures that each one ofthe notches 82 are aligned with one another along an axis that extendsparallel to the longitudinal axis L of housing 12 throughoutarticulation of the needle assembly. Thus, when needles 16, 18, 20 arein the deployed position (FIG. 3D) and received within needle receivingslots 50, 52, 54, each one of the notches 82 are aligned along lockingchannel 59 such that stylet 13 may be passed through the notches.

Each one of needles 16, 18, 20 also defines a suture channel 88 formedalong an outer surface of the needle, for example, along a length of theneedle's outer circumferential edge 90. A first suture S1, which may bea single continuous suture or may be formed of multiple sutures tied toone another, is wrapped around the needle assembly as follows.

With reference to FIG. 3C, first suture S1 may, for example, enter theproximal end 28 of housing 12 and extend to the base end 70 of needle 16where it is wrapped around needle 16 in the suture channel thereof, thefirst suture may then extend to the base end 72 of needle 18 where it iswrapped around needle 18 in the suture channel thereof, the first suturemay then extend to the base end 74 of needle 20 where it is wrappedaround needle 20 in the suture channel thereof before it connected to adistal end of stylet 13. As a result, when needles 16, 18, 20 pierce theAchilles tendon, first suture S1 is weaved through the tendon as shownin FIG. 6 to form a first suture loop 92, a second suture loop 94, and athird suture loop 96.

Suture loops 92, 94, 96 are formed behind the interior face of thedeployment wall 40 and in needle receiving slots 50, 52, 54. Cinchingsuture 60 (e.g., the portion of the suture S1 located between the thirdsuture loop and stylet 13) may then be pulled through the first, secondand third suture loops 92, 94, 96 for cinching first suture S1 to thetendon.

FIGS. 4, 5A, 5B illustrate exemplary needle assemblies. As shown, eachof these needle assemblies include needles 16, 18, 20. However, it willbe appreciated that either needle assembly may include any number ofneedles including fewer than three needles or more than three needles.In an embodiment, in which the needle assembly only includes needles 16,18, the needles have arc length L1, L2. In embodiments in which theneedle assembly includes three or more needles, two or more of theneedles may have the same or different arc lengths, for example, L1, L1,L2. Moreover, although the needle assemblies illustrated in FIGS. 4, 5A,5B, have arc lengths L1, L2, L3 that increase in length from theproximal end of shaft 14 to the distal end of the shaft, it will beappreciated that the arc lengths of each of the needles need not be inan ascending order, for example, needle 16 may have an arc length L2,needle 18 may have an arc length L1, and needle 20 may have an arclength L3, so long as the needles enter gap 42 simultaneously (i.e., atleast one needle enters the gap at a different time than at least one ofthe other needles).

With specific reference to FIGS. 4A-4D, needle tips 76, 78, 80 include asingle prong 98. Prong 98 may extend from a lateral edge of needles 16,18, 20 and have a tetrahedron or pyramid shape. Prong 98 includes afirst lateral edge 99 that is substantially flush with the lateral edgeof the needle from which it extends and a second lateral edge 100 thattapers toward an opposing lateral edge of the needle in front of suturechannel 88. Thus, when needles 16, 18, 20 pierce a tendon, lateral edge100 diverts tissue away from suture channel 88 and shields the suturechannel, preventing the suture channel from being clogged.

With specific reference to FIGS. 5A and 5B, illustrating a differentneedle assembly, needle tips 76, 78, 80 include a dual pronged tip 102such that each one of the prongs is positioned on a lateral side ofsuture channel 88. Prong 102 may be tapered from the innercircumferential edge 84 of needles 16, 18, 20 toward outer thecircumferential edge 90 of the needles to reduce trauma during piercingof the Achilles tendon.

With reference to FIGS. 7A-7E, use of tissue repair device 10 will nowbe described. A surgeon may introduce housing 12 into a single incisionlocated in the posterior region of a patient's leg, superior to the footand in proximity to a ruptured or damaged Achilles tendon. As shown inFIG. 7A, which illustrates a posterior view of a ruptured tendon,housing 12 may be introduced through a single, small incision, forexample, 3 cm in length. The incision may be in proximity to therupture, inferior to the first Achilles tendon portion AT1 and superiorto the second Achilles tendon portion AT2. Because handle 22 is angledrelative to housing 12, grip 24 may be angled away from the patient'sfoot and remain freely operable without interference.

Once housing 12 has been introduced through the incision, a firstportion of the ruptured Achilles tendon AT1 may be may be slid throughthe opening 32 of the housing and positioned at least partially in gap42. Once suitably positioned, actuator 26 may be rotated or otherwiseactuated to rotate shaft 14, causing needles 16, 18, 20 tosimultaneously articulate. Because needles 16, 18, 20 are mounted alongan axis extending parallel to the longitudinal axis L of housing 12 andhave arc lengths L1, L2, L3, respectively, needle tips 76, 78, 80 willpierce and pass through the first portion of the Achilles tendon AT1 ina sequential order. More specifically, needle tip 80 first pierces thefirst portion of the Achilles tendon at a first location, needle tip 78then pierces the first portion of the Achilles tendon at a secondlocation, and needle tip 76 will then pierce the first portion of theAchilles tendon at a third location. The sequential piercing of theAchilles tendon reduces trauma on the Achilles tendon.

After needles 16, 18, 20 have articulated through the first Achillestendon portion AT1 to the deployed position, needle tips 76, 78, 80 arepositioned in corresponding needle receiving slots 50, 52, 54 asdescribed above and illustrated in FIG. 3D. At this time, notches 82 ofneedles 16, 18, 20 are aligned with stylet channel 56 and first sutureS1 has been passed through the Achilles tendon as shown in FIG. 4forming suture loops 92, 94, 96.

A user may then push stylet 13 through locking channel 56 (from theposition shown in FIG. 3C to the position shown in FIG. 3D). After tip61 has emerged from locking channel 56, the user may pull the tip in theproximal direction to pull a rear end of stylet 13 through transitionsection 60 and locking channel 59. This, in turn, passes cinching suture60 through suture loops 92, 94, 96, as illustrated in FIG. 7B and causessuture S1 to slide off of needles 16, 18, 20 as the suture is tensionedover its entire length and to the first portion of the Achilles tendonATE Each one of needles 16, 18, 20 may then be retracted to theirpre-deployment positions, for example, by actuating actuator 26 in areverse direction.

With the first portion of Achilles tendon AT1 secured, the tissue repairassembly 10 may then be removed from the incision and the same tissuerepair device 10 (or a second device) with a second suture S2 may bere-introduced through the same incision in the opposing direction. Thesecond portion of the Achilles tendon AT2 may then be positioned withinthe gap 42 of housing 12 as shown in FIG. 7C. The suture deliveryassembly 10 may then again be actuated as described above to securesecond suture S2 to the second Achilles tendon portion AT2 as shown inFIG. 7D. Suture delivery assembly 10 may then again be removed and thefirst and second sutures S1, S2 may be tied to one another toapproximate and secure the terminal ends of the first and secondAchilles tendon portions AT1, AT2 against one another to facilitatehealing as shown in FIG. 7E.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

The invention claimed is:
 1. A tissue repair apparatus, comprising: ahousing defining a gap between a first edge of the housing and a secondedge of the housing, the gap adapted to receive tissue; a rotatableshaft at least partially disposed within the housing; and first andsecond curved needles articulable within the housing from a deliveryposition, at which the first and second needles are spaced from the gap,to a deployed position, at which the first and second needles extendthrough the gap, wherein each of the first and second curved needles hasan equal radius of curvature and a different arc length, and whereineach of the first and second curved needles is mounted on the shaftalong an axis extending parallel to a longitudinal axis of the housing,wherein rotation of the shaft simultaneously articulates the first andsecond needles and causes the first needle to enter the gap before thesecond needle enters the gap.
 2. The apparatus of claim 1, wherein abase end of the first needle and a base end of the second needle aremounted on an outer surface of the rotatable shaft along an axis thatextends parallel to a longitudinal axis of the rotatable shaft.
 3. Theapparatus of claim 1, wherein the first and second needles and therotatable shaft are a single monolithic structure.
 4. The apparatus ofclaim 1, wherein the first needle includes a first notch spaced a firstdistance from a piercing tip of the first needle and the second needleincludes a second notch spaced a second distance from a piercing tip ofthe second needle, the first distance being greater than the seconddistance.
 5. The apparatus of claim 1, wherein the first needle definesa suture channel along an outer portion of the first needle and thesecond needle defines a suture channel along an outer portion of thesecond needle.
 6. The apparatus of claim 5, further comprising a suturehaving a first portion disposed in the suture channel of the firstneedle forming a first loop, and a second portion disposed in the suturechannel of the second needle forming a second loop.
 7. The apparatus ofclaim 6, wherein the first needle includes a first notch spaced a firstdistance from a piercing tip of the first needle and the second needleincludes a second notch spaced a second distance from a piercing tip ofthe second needle, the first distance being greater than the seconddistance, and wherein the first portion of the suture spans the firstnotch and the second portion of the suture spans the second notch. 8.The apparatus of claim 1, further including a stylet adapted to carry acinching suture, the stylet being slidably disposed within a lockingchannel defined within a wall of the housing.
 9. The apparatus of claim8, wherein the first needle includes a first notch spaced a firstdistance from a piercing tip of the first needle and the second needleincludes a second notch spaced a second distance from a piercing tip ofthe second needle, the first distance being greater than the seconddistance, and wherein when the first needle and the second needle are inthe deployed position, the first notch and the second notch arelongitudinally aligned with one another along the locking channel.
 10. Atissue repair apparatus, comprising: a housing defining a gap between afirst edge of the housing and a second edge of the housing, the gapadapted to receive tissue; a rotatable shaft at least partially disposedwithin the housing; and a plurality of curved needles connected to therotatable shaft, the plurality of curved needles being articulable froma delivery position in which the plurality of curved needles are spacedfrom the gap to a deployed position in which the plurality of curvedneedles extend through the gap, wherein each of first and second curvedneedles of the plurality of curved needles has an equal radius ofcurvature and a different arc length, and wherein each of the first andsecond curved needles is mounted on the shaft along an axis extendingparallel to a longitudinal axis of the housing, wherein rotation of theshaft simultaneously articulates the plurality of curved needles andcauses each one of the plurality of curved needles to enter the gap in asequential order.
 11. The apparatus of claim 10, wherein the pluralityof curved needles comprises the first curved needle having the first arclength, the second curved needle having the second arc length, and athird curved needle having a third arc length, wherein the first arclength is longer than the second arc length and the second length islonger than the third arc length.
 12. The apparatus of claim 11, whereinthe first curved needle includes a first notch spaced a first distancefrom a piercing tip of the first needle, the second curved needleincludes a second notch spaced a second distance from a piercing tip ofthe second needle, and the third needle includes a third notch spaced athird distance from a piercing tip of the third needle, wherein thefirst distance is greater than the second distance and the seconddistance is greater than the third distance.
 13. The apparatus of claim12, wherein when the plurality of needles are in the deployed position,the first notch, the second notch, and the third notch arelongitudinally aligned with one another along a locking channel providedat least partially within a wall of the housing.
 14. The apparatus ofclaim 13, further including a stylet adapted to carry a cinching suture,the stylet being slidably disposed within the locking channel.
 15. Theapparatus of claim 10, wherein the plurality of curved needles comprisesthe first curved needle, the second curved needle, and a third curvedneedle, and wherein each one of the first curved needle, the secondcurved needle, and the third curved needle define a suture channel alongan outer radial edge of the needle.
 16. The apparatus of claim 15,further comprising a contiguous suture having a first portion disposedin the suture channel of the first needle forming a first loop, a secondportion disposed in the suture channel of the second needle forming asecond loop, and a third portion disposed in the suture channel of thethird needle forming a third loop.
 17. The apparatus of claim 15,wherein a piercing end of at least one of the plurality of needlescomprises dual prongs and at least a portion of the suture channel isprovided between the prongs.
 18. The apparatus of claim 10, wherein apiercing end of at least one of the plurality of needles comprises asingle prong, the single prong being substantially tetrahedron shaped orpyramidal shaped and tapered from a first lateral side of the singleprong to a second lateral side of the single prong.
 19. The apparatus ofclaim 10, wherein when the plurality of needles are in the deliveryposition, each one of the plurality of needles is at least partiallypositioned within a wall of the housing and on a single side of the gap.20. A tissue repair apparatus, comprising: a housing defining a gapbetween a first edge of the housing and a second edge of the housing,the gap adapted to receive tissue; a rotatable shaft at least partiallydisposed within the housing; and a plurality of curved needles connectedto the rotatable shaft, the plurality of curved needles beingarticulable from a delivery position in which the plurality of curvedneedles are spaced from the gap to a deployed position in which theplurality of curved needles extend through the gap, wherein rotation ofthe shaft simultaneously articulates the plurality of curved needles andcauses each one of the plurality of curved needles to enter the gap in asequential order, wherein the plurality of curved needles comprises afirst curved needle having a first arc length, a second curved needlehaving a second arc length, and a third curved needle having a third arclength, wherein the first arc length is longer than the second arclength and the second length is longer than the third arc length, andwherein the first curved needle includes a first notch spaced a firstdistance from a piercing tip of the first needle, the second curvedneedle includes a second notch spaced a second distance from a piercingtip of the second needle, and the third needle includes a third notchspaced a third distance from a piercing tip of the third needle, whereinthe first distance is greater than the second distance and the seconddistance is greater than the third distance.